Peninsula Renal Care

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

PENINSULA RENAL CARE

Practice address

1340 South Division Street
Ste 302
Salisbury, MO 21804

Phone

(410) 742-1800

Fax

(410) 548-1288

NPI assigned

Jul 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Constante J Tan, MD

Title

Medical Director

Phone

(410) 742-1800

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245259308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 SOUTH DIVISION STREET",
            "address_2": "STE 302",
            "city": "SALISBURY",
            "state": "MO",
            "postal_code": "21804",
            "telephone_number": "410-742-1800",
            "fax_number": "410-548-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 SOUTH DIVISION STREET",
            "address_2": "STE 302",
            "city": "SALISBURY",
            "state": "MO",
            "postal_code": "21804",
            "telephone_number": "410-742-1800",
            "fax_number": "410-548-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA RENAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "CONSTANTE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "410-742-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Salisbury, MO
• Providers in Salisbury, MO by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.